Fillable MECHANICS LIEN Space above this line for recorders

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MECHANICS LIEN Space above this line for recorders

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Recording Requested By and When Recorded Mail To:
Space above this line for recorder’s use only
(To be recorded in the county recorder’s office
in the county in which the property is located.)
MECHANICS LIEN
NOTICE IS HEREBY GIVEN that Claimant (legal name and address), claims a lien for labor,
service, equipment, or material under the laws of the State of ___________________, upon the premises hereinafter
described, and upon every estate or interest in such structures, improvements and premises held by any party holding any
estate therein. The work was furnished for the construction of those certain buildings, improvements, or structures, now
upon that certain parcel of land situated in the County of ____________________, State of ___________________, said
land described as follows:
STREET ADDRESS: ____________________________________________________________
and/or
LEGAL DESCRIPTION: ____________________________________________________________
The lien is claimed for the following labor, service, equipment or material furnished by the Claimant:
(describe generally). Claimant is owed $ for work furnished to the work of improvement, after deducting
all just credits and offsets, plus interest at the legal rate from the date of this lien. The name of the person or company by
whom Claimant was employed, or to whom Claimant furnished the work is: .
The name(s) and address(es) of the owner(s) or reputed owner(s) of the real property is/are:
.
Name of Claimant: .
Date: By: __________________________________________________
Signature
.
Print Name & Authorized Capacity
Verification
I, the undersigned, declare: I am the (authorized capacity/title), for the Claimant named in the foregoing claim of mechanics lien:
I am authorized to make this verification for the Claimant: I have read the foregoing claim of mechanics lien and know the contents thereof, and the
same is true of my knowledge. I certify (or declare) under penalty of perjury under the laws of the State of ____________ that the foregoing is true
and correct.
Executed on , 20 _____ at __________________________________ . _____________________________________________
Signature of Claimant or Authorized Agent
C&B Forms - revised March 2012 Page One
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PROOF OF SERVICE AFFIDAVIT
Failure to serve the Mechanics Lien and Notice of Mechanics Lien on the owner, or alternatively if the owner
cannot be served on the lender or original contractor, shall cause the Mechanics Lien to be unenforceable as a matter of
law (Civil Code Section 8416(e)). Service of the Mechanics Lien and Notice of Mechanics Lien must be by (1) registered
mail, (2) certified mail, or (3) first-class mail evidenced by a certificate of mailing; postage prepaid, and to a residence or
business address for the owner, lender or contractor. Further, a Proof of Service Affidavit (below) must be completed and
signed by the person serving the Mechanics Lien and Notice of Mechanics Lien. This page should be completed (either
one of the sections below) and recorded with the County Recorder along with the Mechanics Lien and Notice of
Mechanics Lien.
AFFIDAVIT FOR SERVICE ON THE OWNER
I, (name), declare that I served a copy of this Mechanics Lien and Notice of Mechanics Lien by
registered mail, certified mail, or first-class mail evidenced by a certificate of mailing, postage prepaid, addressed as
follows to the owner(s) or reputed owner(s) of the property:
Company /Person served: ,
Title or capacity of person or entity served: .
Service Address: .
Said service address is the owner’s residence, place of business, or address shown by the building permit on file with the
permitting authority for the work or the address identified on the construct trust deed.
Executed on , 20 (date), at (city), _____________ (state).
By:___________________________________________
(signature of person serving)
ALTERNATE AFFIDAVIT FOR SERVICE ON THE CONSTRUCTION LENDER OR ORIGINAL CONTRACTOR
I, (name), declare that that the owner or reputed owner cannot be served with a copy of this
Mechanics Lien and Notice of mechanics Lien by registered mail, certified mail, or first-class mail. Pursuant to State law, I
served a copy of this Mechanics Lien and Notice of Mechanics Lien by registered mail, certified mail, or first-class mail
evidenced by a certificate of mailing, postage prepaid, addressed as follows to the construction lender or original
contractor as follows:
Company /Person served: ,
Title or capacity of person served (if appropriate): .
Service Address: .
Executed on , 20 (date), at (city), _______________.
By:___________________________________________
(signature of person serving)
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Completed 24 August 2021

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